Adoption Application
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Which Animal are you interested in? *
First Name *
Last Name *
Phone Number *
What is your email? *
Physical Address *
City *
State *
County *
Please Provide a personal reference (Name, Phone Number, Address) *
Please Provide a second personal reference (Name, Phone Number, Address) *
Do you Rent or Own your home? *
Will the animal be around children? If yes, how many and what ages? *
What does your housing situation include? (check all that apply) *
How many pets do you currently have? *
Are your current animals up to date on all vaccinations?
Veterinarian name and phone number *
Are you willing to provide regular veterinary care, including vaccinations, flea/tick prevention, and routine check-ups? *
Why are you interested in adopting this animal? *
What qualities are you looking for in a pet? *
Have you ever surrendered or euthanized an animal? If yes, what were the circumstances *
Have you ever surrendered or euthanized an animal? If yes, what were the circumstances *
What type of animal training have you done?
 *
If this is a dog, do you have a plan for exercise and socialization? *
How do you plan to introduce your pet to new animals and people? *
Agree and Submit

By typing your name you agree to the following: I understand that the adoption process may involve a home visit and/or reference checks. I agree to provide a loving and responsible home for the animal and to adhere to the guidelines set forth by the adoption agency/shelter. I understand that many of these animals are rescue animals and their medical history is unknown. These animals are NOT tested for disease. The animal breed is not definite, and not guaranteed in any way. If the animal is not yet spayed or neutered, I agree to make arrangements with my Veterinarian to have the procedure done within 30 days after adoption. I fully understand that adoption of these animals carries a risk of injury, including being bitten or scratched. My signature below attests to my intent to hold harmless and release from all liability to Blue Mountain Humane Association and its agents from all acts which are related to normal risk associated with the adoption of an animal including illness this animal may incur or currently have. Blue Mountain Humane Association reserves the right to deny any application that is deemed unsuitable for the animal. The Adoption Fee is non-refundable.

Full Name *
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This form was created inside of Blue Mountain Humane Association.